They got Karen back on the PCA pump around 5 or 6pm, and with a higher dosage than before. She's been able to bring her pain back to around a 4 or 5, and seems at least somewhat comfortable. Her heart rate has been somewhat elevated since the surgery, but it's in the mid 120s now. Her temperature was 99.8°F when they tested it last. And lastly, she's has an NPO order for after midnight - which means no food or water.
I guess when they said a doctor would be coming around later they just meant sometime later in the day. A pair of them came in about 10pm. They say what Karen has is a hematoma - a collection of blood within the tissue. They says it's actually pretty common and not something we should worry too much about. They also said her blood counts have gone up slightly since she received the platelets, so that could mean whatever internal bleeding she had has stopped. It could also mean she isn't getting enough liquids and her blood is simply thicker. So they want to make sure she's getting enough fluids. They will reevaluate in the morning, and one thing they may decide at that time is to give her more blood product to help things clot. They also said the NPO after midnight is in case they decide they have to go in surgically to resolve the situation. We asked if they could just drain it with a needle and they said that's one thing they will be discussing with our surgeon, but they want to watch the situation till morning, and want her ready in case surgery turns out to be the best option. They may also do an ultrasound to look at the hematoma before making a decision, but that would also be in the morning. Often times the body will simply reabsorb the blood without intervention. We asked about the increased temperature and were told it's common with hematoma and not a concern yet. The heart rate is probably also related to the hematoma, but other things such as pain or dehydration can cause an increased heart rate.
They're giving her 500ml of Albumin, which is the primary protein found in the blood. If she is dehydrated this should also help pull some fluid back into her blood. Now we wait until morning.
Sunday, February 14, 2016
Something's Wrong
Karen slept alright last night, but not as well as the night before. She woke up this morning with a small fever of 99.2°F. Looking over her labs I can see her blood counts have been dropping since yesterday. The doctors think there must be some internal bleeding and one called it hemorrhaging. They have put a stop to her heparin shots. It's a blood thinner that's given to you when they don't think you'll be moving around much so you don't get blood clots. They're painful, burning, "horrible" shots and her primary motivation in getting up and walking around has been being able to refuse them.
She's been walking around a decent amount since they took her off bed rest, but now I wonder if she came off it too soon. Her abdomen has continued to swell throughout the day and her pain level has continued to rise as well. This morning she thought she could do without the PCA pump, just taking oxycodone orally. This, however, turned out to be some bad timing. The unexpected swelling/hemorrhaging has increased her pain level at the same time she agreed to start backing off the pain meds. She can still get something through the IV once an hour, but her pain level jumps up to about 8 out of 10 between doses now.
They took her off food and fluids about an hour ago and gave her an infusion of platelets. They wouldn't do this unless they were also thinking surgery might be required. They said depending on how her blood work turns out after the infusion, she might be able allowed to eat and drink again. And... that was pretty fast, they've lifted the food and water restrictions. That seems almost too fast for them to know anything. The nurse tells us someone should be coming around to talk to us. I'll update again when we know more.
She's been walking around a decent amount since they took her off bed rest, but now I wonder if she came off it too soon. Her abdomen has continued to swell throughout the day and her pain level has continued to rise as well. This morning she thought she could do without the PCA pump, just taking oxycodone orally. This, however, turned out to be some bad timing. The unexpected swelling/hemorrhaging has increased her pain level at the same time she agreed to start backing off the pain meds. She can still get something through the IV once an hour, but her pain level jumps up to about 8 out of 10 between doses now.
They took her off food and fluids about an hour ago and gave her an infusion of platelets. They wouldn't do this unless they were also thinking surgery might be required. They said depending on how her blood work turns out after the infusion, she might be able allowed to eat and drink again. And... that was pretty fast, they've lifted the food and water restrictions. That seems almost too fast for them to know anything. The nurse tells us someone should be coming around to talk to us. I'll update again when we know more.
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